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Liver is the largest organ in the body which plays an important role in the digestion of food. Liver cancer is cancer that begins in the cells of your liver. Hepatocellular carcinoma is the most common type of liver cancer, which begins in the hepatocyte, a main type of liver cell. Other types of liver cancer include hepatoblastoma and intrahepatic cholangiocarcinoma which are less common.

There are two types of liver cancer, primary and secondary. Primary liver cancer originates in the liver. Secondary liver cancer also known as metastatic liver cancer are most common, where the cancer spreads to the liver from other areas of the body, such as lung, colon or breast.

Types Of Liver Cancer

There are many types of liver cancer that are classified based on the type of cells. In general, liver cancer is categorized broadly into two types:

  • Primary liver cancer
  • Secondary liver cancer

Primary liver cancer: It is a type of cancer that begins in the liver. Based on the type of cells, primary liver cancer can occur in the following types.

  • Hepatocellular carcinoma (HCC): It is the most prevalent type of liver cancer and is often referred to as hepatic tumors or hepatomas. Men are more prone than women to develop liver cancer. This condition occurs in the main type of liver cells, called hepatocellular cells. Cirrhosis, nonalcoholic fatty liver disease, hepatitis B, or hepatitis C are the main causes of HCC.
  • Fibrolamellar hepatocellular carcinoma (FHCC): It is a rare subtype of Hepatocellular carcinoma (HCC), and it is most common in women younger than age 35.
  • Cholangiocarcinoma: It is also a rare type of primary liver cancer. It develops in the small, tube-like bile ducts within the liver that carry bile to the gallbladder and is otherwise known as bile duct cancer. Primary sclerosing cholangitis (PSC),
    cirrhosis, bile duct stones, or hepatitis B or C infection are the main risk factors. It has two sub-types namely:
    1. Extrahepatic cholangiocarcinoma begins in the section of ducts outside the liver.
    2. Intrahepatic cholangiocarcinoma begins in the section of ducts inside the liver. It is otherwise known as Intrahepatic cancer.
  • Angiosarcoma: It is a rare type of cancer called soft tissue sarcoma that begins in the blood vessels of the liver and grows quickly. It is typically diagnosed at a more advanced stage and often known as hemangiosarcoma.
  • Hepatoblastoma: It is an extremely rare kind of liver cancer that develops in children, usually those younger than four years old. The cells of hepatoblastoma are similar to fetal liver cells. It has been linked to preeclampsia in the mother, maternal smoking before or during pregnancy, and low birth weight.

Secondary liver cancer: It develops when cancer cells spread to the liver from primary cancer somewhere else in the body. If cancer cells break away from primary cancer, they can spread to another part of the body via the lymphatic or blood systems, where they can form a new tumor. It is referred to as metastasis or secondary cancer.

Other Types of Liver Cancer:

Benign liver tumors: It can grow to be large, but they do not invade surrounding tissues or spread to other parts of the body. The three primary types of benign liver tumors are as follows:

  • Hemangioma: It is the most common type of benign liver tumor that can begin in blood vessels. Most hemangioma are asymptomatic and do not require treatment. However, some of them could bleed and require surgical removal.
  • Hepatic adenoma: It begins from hepatocytes (the main type of liver cell). The majority of hepatic adenoma are symptomless and do not require treatment. However, some eventually result in symptoms like pain, a lump in the belly, or bleeding. These tumors are more likely to develop in women who use birth control pills. It can also occur in men who use anabolic steroids. When these medications are withdrawn, adenomas may shrink.
  • Focal nodular hyperplasia (FNH): It is a tumor-like growth made up of several cell types (hepatocytes, bile duct cells, and connective tissue cells). It affects women more frequently. Although FNH tumors are benign, they can induce symptoms.

Stages Of Liver Cancer

There are various staging systems for liver cancer. Barcelona Clinic Liver Cancer (BCLC) Staging System is commonly used for primary liver cancer. This system evaluates your liver's functional ability, the size of the tumor, and symptoms when you have HCC.

The BCLC staging system has the following stages:

  • Stage 0 - Very early stage: The tumor is less than 2 cm in size, and there is no increased pressure in the liver's main blood veins (portal vein). Bilirubin levels are normal in this stage, and surgery is usually recommended.
  • Stage A - Early stage: The tumor is less than 5 cm in size, and liver function may vary. Your blood vessels may have become infected by this tumor. People with the early-stage disease can be candidates for a liver transplant, surgery, or radio frequency ablation (RFA).
  • Stage B - Intermediate stage: In this stage, the tumor may be large or several tumors that measure more than 5 cm. This tumor may spread to your lymph nodes, large blood vessels, or another organ.
  • Stage C - Advanced stage: The tumor has progressed to other organs, such as the lymph nodes, lungs, bones, and other body parts. Typically, physicians recommend targeted therapy.

Causes & Risk Factors of Liver Cancer

Age: Primary liver cancer occurs most often in people older than 60.

Gender: Liver cancer is much more common in men than in women.

Hepatitis B virus (HBV) infection: Chronic HBV infection is the major cause of liver cancer. It can spread through body fluids such as blood, semen, or urine. The virus may be transmitted from mother to child at childbirth, via sexual contact, or through sharing needles. It may result in inflammation of the liver, leading to liver cancer.

Hepatitis C virus (HCV) infection: HCV is also a leading cause of liver cancer. It can be transmitted through sexual contact, sharing needles, and blood. This infection can cause cirrhosis which is a major risk factor for liver cancer.

Cirrhosis: It is a progressive and irreversible condition that causes scar tissue to accumulate in the liver and increases the risk of developing liver cancer.

Diabetes: People with type 2 diabetes are more likely to be overweight or obese. Obesity with diabetes generally promotes the progression of liver cirrhosis by carcinogenesis which might be a risk factor for developing liver cancer.

Non-alcoholic fatty liver disease: It is a common condition in obese individuals. A sub-type of this condition known as non-alcoholic steatohepatitis (NASH) can result in cirrhosis and possibly liver cancer.

Primary biliary cirrhosis: It is an autoimmune disease that damages or even destroys the liver's bile ducts and can result in cirrhosis. People with advanced PBC are at a higher risk of developing liver cancer.

Inherited metabolic diseases: Cirrhosis and liver cancer may result from some inherited metabolic disorders. Patients with hereditary hemochromatosis absorb excessive iron from their diet. Iron settles in tissues all over the body, including the liver. If there is an excessive buildup of iron, it causes cirrhosis and liver cancer.

Exposure to aflatoxin: Aflatoxin is a poison produced by a mold that can grow on stored nuts and grains. Food contaminated with aflatoxin can raise the risk of developing liver cancer.

Exposure to chemicals: Live cancer risk is increased by several chemicals, including vinyl chloride and thorium dioxide (Thorotrast). Vinyl chloride produces certain polymers, and thorotrast is administered to some patients during specific x-ray scans.

Excessive alcohol use: Drinking excessive alcohol daily might cause irreversible liver damage and raise the risk of developing liver cancer.

Cigarette smoking: Smoking increases the risk of liver cancer. The higher the number of cigarettes smoked each day and the number of years smoked greater is the risk.

Anabolic steroids: Some athletes take anabolic steroids (male hormones) to gain strength and muscle mass. Using anabolic steroids over a long period may raise the risk of liver cancer, such as hepatocellular carcinoma.

Symptoms of Liver Cancer

  • Abdominal discomfort, pain
  • Jaundice (yellowing of skin or eyes)
  • Unexplained weight loss
  • Nausea and vomiting
  • Loss of appetite
  • Weakness or Fatigue.
  • Pale, chalky stools
  • Dark-colored urine
  • Lump in the right side of abdomen
  • Pain in your right shoulder
  • Feeling very full after a small meal
  • Bruising or bleeding
  • Itching

Liver Cancer Screening

Screening tests are performed when you are healthy and have no signs or symptoms of the disease, and they can help in the early detection of cancer so successful treatment can begin. Ultrasound and Alpha-fetoprotein testing is the screening test for liver cancer.

Ultrasound (Sonography): It is the first screening test if Hepatocellular carcinoma (HCC) is detected. Your doctor might suggest an ultrasound scan if you have symptoms of cancer that start in the liver (primary liver cancer). The ultrasound can show changes in the liver, including abnormal growth.

Alpha-fetoprotein test: Liver cancer can cause elevated blood levels of a protein known as alpha-fetoprotein (AFP) and this test may be used as a tool for liver cancer screening. AFP levels may rise during pregnancy, hepatitis, and different cancer types. However, AFP is not a perfect marker for liver cancer, and other researchers believe it should not be the only screening test performed.

Liver Cancer Diagnosis

A liver cancer diagnosis is usually made after any symptoms appear or if screening tests indicate the risk of cancer. The type of diagnostic tests varies depending on the type of cancer, symptoms, age, and the results of the previous testing.

To diagnose liver cancer, your doctor may ask about your medical history and family history and conduct a physical exam. Report to your doctor if you have a history of long-term liver problems, heavy alcohol consumption, or hepatitis B or C infection.

Diagnostic procedures and tests for liver cancer include:

Physical examination and medical history: A physical examination of the body is performed to assess a person's health. This includes looking for any abnormalities or lumps that might be symptoms of the disease. Additionally, a history of the patient's health habits, diseases, and treatments is also examined.

Blood tests: Doctors may perform blood tests for cancer, such as a liver function test, to check for liver enzymes, proteins, and other substances that indicate whether your liver is healthy or damaged.

Computed tomography (CT) scan: This specialized form of X-ray creates detailed images of your liver and provides details on the size and location of liver tumors.

Magnetic resonance imaging (MRI): It uses a powerful magnet, radio waves, and a computer to produce extremely clear images of your body. This procedure is otherwise known as magnetic resonance angiography.

PET scan: This process is used to identify malignant tumor cells within the body. A small amount of radioactive glucose is injected into a vein. The PET scanner spins around the body to provide an image of where glucose is being utilized.

Angiogram: It is a test that aids medical professionals in examining the blood vessels in your liver. Your healthcare provider administers dye into your arteries during this test so they can monitor blood vessel activity and check for blockages.

Biopsy: Medical professionals remove liver tissue and examine it for indications of malignancy. It is the most accurate method for diagnosing liver cancer. Types of biopsy used in liver cancer include:

  • Fine-needle aspiration biopsy: A fluid, tissue, or cell sample is taken by using a thin needle.
  • Core needle biopsy: A cell or tissue sample is taken by using a slightly wider needle.
  • Laparoscopy: It is used to examine the organs inside the abdomen to look for disease symptoms.

If your healthcare professional suspects you may have Intrahepatic cancer (IHC), they might do the following tests:

  • Endoscopic retrograde cholangiopancreatography (ERCP) examines your bile ducts using an endoscope and a catheter (thin, flexible tubes).
  • Percutaneous transhepatic cholangiography (PTC) uses X-rays to examine any abnormality in the bile ducts. Your healthcare professional inserts a needle into your liver and bile ducts to take samples of abnormal areas. PTC is used for those who cannot get an ERCP.

Liver Cancer Treatment

Depending on the individual's age, type of liver cancer, the extent (stage) of liver cancer, overall health, and the patient's preference, the doctor may recommend the treatment options. The major treatment types for liver cancer include surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy.

Surgery is one of the most common treatments for early-stage liver cancer (primary liver cancer). People having healthy liver are also prone to develop liver cancer, such as fibrolamellar carcinoma and surgery is an option for these patients.

Types of Liver cancer surgery include:

  • Liver resection: Resection refers to the removal of cancer and the surrounding tissues in your liver. Your doctor may advise to remove the tumor by surgery if it is tiny and your liver is healthy, and cancer has not grown into the blood vessels.
  • Lobectomy: A liver lobe may be removed by your surgeon, and this procedure is known as a lobectomy or Hemi hepatectomy.
  • Liver transplant surgery: This surgery removes a diseased liver and replace it with a healthy liver from a donor.

Radiation therapy is a better option if other treatments are not feasible. It uses high-energy X-rays and protons to damage the DNA of cancer cells and shrink tumors. This damage inhibits malignant cells from proliferating. For people with advanced liver cancer, radiation therapy may be used to control the symptoms.

Various radiation therapy methods for liver cancer include:

  • Internal radiotherapy refers to receiving radiotherapy inside the body. Selective internal radiotherapy (SIRT) is a type of internal radiotherapy which uses radioactive beads to treat liver cancer. It is also known as radioembolization or trans arterial radioembolization (TARE).
  • External radiotherapy uses a machine outside the body that targets radiation at cancer. Stereotactic body radiotherapy (SBRT) is a specialized type of external radiation therapy that includes directing multiple beams of radiation at one point on your body simultaneously. This is the best treatment option for hepatocellular carcinoma.

Chemotherapy is the use of drugs to kill rapidly growing cancer cells, and it can be given through a vein in your arm. Chemotherapy is indicated to treat advanced liver cancer.

Targeted therapy can identify and target the genes or proteins involved in cancer cell proliferation and multiplication by preventing cancer growth. Some targeted treatments are only effective in patients whose cancer cells have specific genetic mutations.

Immunotherapy uses our disease-fighting immune system to fight cancer. It can identify and destroy any abnormal cells and prevent some cancerous growth. Advanced liver cancer patients can benefit from immunotherapy treatments. Atezolizumab and bevacizumab are immunotherapy drugs, and this combination has been used to treat Hepatocellular carcinoma (HCC).

Supportive (palliative) care is specialized medical care that focuses on relieving pain and other symptoms associated with a serious illness. Palliative care can be used while receiving other types of treatment, including surgery, chemotherapy, or radiation therapy.

Liver Cancer Prognosis

According to the National Cancer Institute, the prognosis is defined as, "The likely outcome or course of a disease; the chance of recovery or recurrence."

Liver cancer prognosis depends upon various factors such as:

  • Age
  • Gender
  • Histologic type
  • Size and stage of cancer
  • Liver function
  • Patient's general health and response to the treatment

10 Tips to Prevent Liver Cancer

  • Prevent Hepatitis C: There are no hepatitis C vaccines available, but the infection can be prevented by taking a few preventive measures such as safe sex practices, using sterilized needles in hospitals, while getting a tattoo or piercing.
  • Get vaccinated: Every child should be vaccinated against hepatitis B. Adults who abuse intravenous medications and those who exhibit symptoms of hepatitis B should get immunized.
  • Limit alcohol consumption.
  • Give up smoking and using other tobacco products.
  • Avoid being exposed to cancer-causing chemicals or toxins.
  • Exercise regularly and maintain a healthy weight.
  • Make sure to eat plenty of whole grains, fresh fruits, vegetables, and fiber.
  • Avoid fatty foods to improve liver health.
  • To lower the chance of liver cancer, treat hereditary conditions.
  • Ask your healthcare professional about liver cancer screenings if you are a heavy drinker, have diabetes, obesity, or have any liver condition.

Liver Cancer FAQs

1. What is the main cause of liver cancer?

The most common cause of liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). These infections cause cirrhosis that leads to liver cancer.

2. What symptoms might I observe if I have liver cancer?

Abdominal discomfort, pain, jaundice, weight loss, nausea, vomiting, loss of appetite, weakness, pale or chalky stools, dark-colored urine, lump in the right side of the abdomen, pain in the right shoulder, feeling full after a small meal, bruising or bleeding and itching are the symptoms of liver cancer.

3. Who is most at risk for liver cancer?

Liver cancer can happen at any age, but it occurs most commonly in people older than 60.

4. Can liver cancer spread quickly?

Depending on the type of disease, liver cancer can spread quickly. For example, hemangiosarcoma and angiosarcoma are types of liver cancer that spread quickly.

5. Can primary biliary cirrhosis (PBC) increase the risk of developing liver cancer?

Yes. PBC increases your risk of developing liver inflammation and damaging bile ducts in the liver. Consult with your healthcare provider about the specific risks, screening tests, and treatment options available.

6. Should I be concerned if I have a liver cyst?

There is no concern about inflammation and liver cysts; it has no signs or symptoms and doesn't need to be treated. These cystic tumors rarely develop into malignant tumors and spread beyond the liver. When cysts are growing, extra care should be taken to prevent complications.

7. Are fatty liver disease and liver cancer related?

Patients who have a very specific type of fatty liver disease, like non-alcoholic steatohepatitis, are more likely to get liver cancer in the future.

9. What can be done to increase the survival rate?

Early screening for cancer is the best method to treat it as soon as possible, thereby enhancing the survival rates. Regular screening practices can assist ensure early detection and treatment of cancer.


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